Provider Demographics
NPI:1114046778
Name:CROWDER FAMILY CARE
Entity type:Organization
Organization Name:CROWDER FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:W
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-428-4675
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:NC
Mailing Address - Zip Code:27356-0602
Mailing Address - Country:US
Mailing Address - Phone:910-428-4675
Mailing Address - Fax:
Practice Address - Street 1:444 CRAVEN ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:NC
Practice Address - Zip Code:27356-0602
Practice Address - Country:US
Practice Address - Phone:910-428-4675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL062002310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7801949Medicaid